Relationship between Sleep Deprivation, Drowsy Driving Episodes, and Accidents among the Night Shift Hospital Nurses - Literature review Example

Relationship between sleep deprivation, drowsy driving episodes and accidents among the night shift Hospital nurses (Registered Nurses) Research has shown that at least more than 40,000 injuries, 100,000 automobile crashes and 1500 fatalities occur each year and they are attributed to the tendency of the nurses to fall asleep behind the wheel (National Highway Transportation Safety Administration, 2006). Statistics have further shown that road crashes leading to serious injuries and fatalities are caused by high speed driving and they are related to fatigue derived from long hours of working at night among the hospital nurses (NHTSA, 2006). Studies have further established that fatigue-related crashes involve a single vehicle driven by a driver who has less control to avoid road cash (NHTSA, 2006). On many occasions, the driver is alone because most of the nurses leave hospitals to join their families at home after their night shift duty. Drowsy driving is therefore a common phenomenon that leads to a crash or near crash among the drowsy driving drivers. According to the National Highway Traffic Safety Administration (NHTSA), more than 100 million adults admit to have fallen asleep at some point while driving (National Highway Traffic Safety Administration, 2006). In a poll dubbed “Sleep in America” conducted in 2005, findings revealed that more than seventy percent of the study participants in the poll admitted to have fallen asleep while driving at more than 60mph or more on roadways (National Highway Traffic Safety Administration, 2006). The study also revealed that10 million drivers reported to have been involved in a road crash related to drowsy driving or a near road crash that would have been fatal (Pack, Pack and Rodgman et al, 2005). Naturalistic studies conducted on driver behavior have also shown that more than 20% to 25% of near crashes as well as real motor vehicle crashes are caused by moderate to severe levels of drowsiness among the drivers on roadways (Pack, Pack and Rodgman et al, 2005). The prevalence rates of motor vehicle crashes are higher among the employed individuals as well as people that work for more than 50 hours per week. MVC is also a common phenomenon among individuals working at night, individuals that work at irregular hours as well as individuals that go for long hours without sleeping (Pack, Pack and Rodgman et al, 2005). Although, different studies have been conducted to establish the relationship between fatigues, stress, sleep deprivation and medical errors among night shift nurses, only a few studies have been conducted on the relationship between drowsy driving and prevalence of motor vehicle crashes among the night shift nurses (McCartt, Rohrbaugh and Hammer, 2000). It is not, therefore, surprising that the few studies conducted on the current topic reveal that medical residents have the highest number of motor vehicle crashes (McCartt, Rohrbaugh and Hammer, 2000). Studies have revealed that during residency, motor vehicle crashes related to fatigue are 5 times higher than motor vehicle crashes that occur before residency (19% vs 5%) (McCartt, Rohrbaugh and Hammer, 2000). Among the residents whose duration of working exceed 24 hours, the risk of motor vehicle crashes related to fatigue as well as the risk of near motor vehicle crashes (2.3 and 5.9) is alarmingly higher than that prevalence of motor vehicle or near motor vehicle crashes that occur among the residents that work for less than 24 hours (Gold, et al, 2004). Studies have also revealed that the likelihood of motor vehicle crashes increased rapidly with every increase in extended shift accounting for an increase of 9% of motor vehicle crashes (Gold, et al, 2004). The statistics above do not apply to one medical subspecialty or specialty but it touches on all medical subspecialty and specialty. This is derived from the fact that more than 20% of anesthesia and emergency medicine residents have testified of being involved in at least one fatigue related crash due to drowsiness on roadways (Gold, et al, 2004). The most acute time during when the reported crashes occurred was between 08:30 and 09:30 am when nurses drive home from a night shift (Gold, et al, 2004). The accidents were reported in both “no traffic” and “moderate” traffic (Gold, et al, 2004). 45% of surveyed pediatric residents in one medical center reported to have slept when traffic lights signaled red while 50% of surveyed pediatric residents in the same medical center reported to have fallen asleep on many occasions behind the wheel and not necessarily at the stop light (Gold et al, 2004). In a different study, more than 75% of anesthesiology residents surveyed reported to have missed a crash related to drowsy driving while more than 65% of emergency medicine residents reported to have missed a near crash after falling sleep on roadways (Gold, et al, 2004). The average number of missed crashes among the anesthesiology residents was between 10 to 15. Laboratory studies have shown that being awake for long duration of hours produces equal performance deficits witnessed in 0.05% alcohol concentration (Philip, Sagaspe, Taillard et al, 2005). Prolonged wakefulness refers to more than 20 hours of being awake. The reason for this is that more than 24 hours consecutive wakefulness hours results into the impairment of reaction time below 0.1% (Philip, Sagaspe, Taillard et al, 2005). 0.1% is the legal minimum level required to operate a motor vehicle on roadways across the United States (Arendt et al, 2005). Arendt and colleagues noted that resident physicians working between 34-38 hours demonstrated high levels of attention lapses, performance impairments, and simulated accidents and decreased vigilance levels while driving (Arendt et al, 2005). The levels of cognitive impairments witnessed among the resident physicians working for 34-38 ours was equivalent to the level of cognitive impairments observed among the drunkards who had consumed alcohol that produced 0.05% concentration in the blood (Arendt et al, 2005). Working for 34-38 hours impaired driver’s performance, and lengthened reaction times and it affected the speed and lane variability (National Sleep Foundation, 2005). Although, fatigue -related and drowsy driving have been demonstrated to be serious among the resident physicians, it is important to take into consideration the fact that resident physicians are just a small number of healthcare providers that work for long duration of hours and later drive home in the morning hours after completion of their night shifts. Statistics show that more than 60% of registered nurses employed in different hospitals in the United States work on rotating or night shifts (National Sleep Foundation, 2005). The length of the shifts range between 10 to 12 hours and may not routinely follow the night, evening and day patterns (Barger, Cade and Ayas et al, 2005). On many occasions, registered nurses are surprised by double shifts (ranging from 15 to 20 hours) which prolongs periods of wakefulness leading to decreased psychomotor and cognitive performance (Barger, Cade and Ayas et al, 2005). As seen above, numerous studies concerning the levels of near and real motor vehicle crashes experienced by resident pediatricians and physicians on rotating shifts have been conducted. However, most studies conducted on hospital nurses focus on importance of napping during rotating or night shifts (Barger, Cade and Ayas et al, 2005). This means that information related to the levels of near and real motor vehicle crashes among the hospital nurses is substantially low. Previous studies such as Leiter and Maslach (2005) have revealed that more than 90% of nurses in intensive care units in different hospitals across the United States have had injuries related to motor vehicle accidents while commuting from work after their rotating or night shifts (Barger, Cade and Ayas et al, 2005). Few studies conducted investigated rates of nurses’ sleepiness while on duty, shift work hours, and the number of motor vehicle injuries experienced by nurses while driving from work during the 08:30 to 09:30 a.m hours (Barger, Cade and Ayas et al, 2005). Results of these investigations revealed that night shift nurses were 10 times more likely to be involved in motor vehicle accidents due to drowsiness than the evening, workday and rotating shift nurses (Barger, Cade and Ayas et al, 2005). Although, all participating nurses reported to have high risks of motor vehicle related injuries, night shift nurses were found to be 5 times more likely to be involved in motor vehicle accidents than nurses on evening and day shifts (Horne and Reyner, 2003). Most of the night shift nurses reported to have more than 7 nods behind the wheel brought by long hours of wakefulness during the night shifts (Horne and Reyner, 2003). In addition, more than 25% of participating nurses reported to have experienced near road crashes while driving home after completing their night shifts (Horne and Reyner, 2003). Evening and day shift nurses reported the lowest number of near road crashes and real road crashes. Investigators such as Gold and colleagues (2004) have established a significant relationship between drowsy driving, type of shift and alertness. However, a serious gap has been left unexamined in relation to the effect of shift duration or shift length on the driving performance of night shift nurses. In this article, we explore the levels and number of drowsy driving incidents that occur among the night shift nurses, the relationship between the number of hours worked by a night shift nurse and occurrence of drowsy driving, the relationship between drowsy driving and the number of motor vehicle related injuries and fatalities among the hospital night shift nurses. Our specific aim will be to demonstrate that the more the number of hours a hospital nurse stays awake during the night shift contributes significantly to the number of motor vehicle related injuries and fatalities among the night shift hospital nurses. The broader aim of the article will be to show that sleep deprivation affect the cognitive performance of individuals not only in the health care sector but also in other fields and is the single most contributor of errors committed by individuals working on night shifts. In order to adequately carry out this investigation, we shall draw upon the elements of quantitative analysis of 895 registered nurses drawn from different parts of the country. Information related to the number of hours worked by individual registered nurses, errors committed by the nurses when driving on roadways, episodes of drowsy driving, the number of nods experienced by RN nurses while driving from work and wake/sleep patterns, will be drawn from logbooks that RN will be required to fill for a three month period. References Arendt, J., Owens, J., Crouch, M., Stahl, J., & Carskadon, M. (2005). Neurobehavioral performance of residents after heavy night calls vs after alcohol ingestion. JAMA; 294:1025–1033. Barger, K., Cade, B., Ayas, N., et al. (2005). Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med. 2005; 352:125–135 Gold, et al. (2004). Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses. Am J Public Health, 82:1011–1014. Horne, J., & Reyner, L. (2003). Vehicle accidents related to sleep: a review. Occup Med. 2003;56:289–294 Leiter, M., & Maslach, C. (2005). Banishing burnout: Six strategies for improving your relationship with work. San Francisco (CA): Jossey-Bass. McCartt, A., Rohrbaugh, J., Hammer, M. (2000). Factors associated with falling asleep at the wheel among long-distance truck drivers. Accid Anal Prev. 2000; 32:493–504. National Highway Traffic Safety Administration. Washington: US Department of Transportation (2006). The impact of driver inattention on near-crash/crash risk. DOT HS 810 594. National Sleep Foundation. (2005). Sleep in America poll. Available at:http://www.sleepfoundation.org/site/c.huIXKjM0IxF/b.2419039/k.14E4/2005_Sleep_in_America_Poll.htm Pack, A., Pack, A., & Rodgman, E, et al. (2005). Characteristics of crashes attributed to the driver having fallen asleep. Accid Anal Prev. 1995; 27:769–775 Philip, P., Sagaspe, P., & Taillard, J, et al. (2005). Fatigue, sleepiness, and performance in simulated versus real driving conditions. Sleep. 2005; 28:1511–1516 Read More